Digital Screening and Brief Intervention for Perinatal Substance Use in Home Visiting

Abstract The early postpartum period is a time of significant risk for escalating substance use (SU), as many people who reduce their SU during pregnancy return to pre-pregnancy levels within 3 months postpartum. Addressing postpartum SU is key to preventing negative maternal and child health outcomes, but postpartum mothers are

unlikely to seek treatment for SU, due to stigma and fear of child removal. Home visiting (HV), a nationally available voluntary supportive intervention for high-risk families during the perinatal period, is a promising venue for reaching new mothers to prevent SU, as it is often one of the only service touchpoints for vulnerable families

during the postpartum period. However, most widely used HV models do not have standardized protocols for identifying and addressing SU risk. Our team adapted an electronic screening and brief intervention (e-SBI) for SU and tailored it to the HV context (SBI-HV). The SBI-HV included an e-SBI completed by HV clients

confidentially in between home visits, and a home visitor facilitation component to support integration of the e- SBI into routine HV. A prior study demonstrated preliminary feasibility and acceptability of SBI-HV. The proposed study aims to further optimize the SBI-HV by applying a factorial design to examine preliminary impacts of three

SBI delivery strategies: a single e-SBI session (main e-SBI), the main e-SBI plus a booster session (booster e- SBI), and 4 weeks of tailored text messaging following e-SBI. Additionally, we will systematically assess implementation facilitators and barriers to inform development of targeted implementation strategies to support

sustainable integration of SBI-HV into routine HV. The proposed R34 will use a Type 1 hybrid implementation- effectiveness design with a pilot 3X2 factorial trial and apply the RE-AIM and PRISM implementation frameworks to achieve the following specific aims: (1) test the impact of 3 SBI-HV delivery strategies (main e-SBI; main e-

SBI + booster; text messaging) on postpartum SU, maternal self-efficacy, motivation to avoid SU, and HV retention; (2) evaluate feasibility, acceptability, fidelity, and facilitators and barriers to the SBI-HV delivery strategies; and (3) develop tailored implementation strategies to support SBI-HV integration into routine HV. We

will partner with the Kansas Healthy Families (HF) multi-site HV system to complete study aims in 3 phases. The pre-implementation phase will include a mixed-methods assessment of PRISM domains aimed at selecting implementation program sites, promoting buy-in from key staff, and informing local adaptations to the SBI-HV.

The implementation phase will include a pilot 3X2 factorial trial with 120 clients and 20 home visitors at 5 sites to obtain proof-of-concept data on the individual and combined impacts of the SBI-HV delivery strategies. The post-implementation phase will include qualitative interviews with factorial trial participants and HV staff to assess

implementation facilitators and barriers, followed by an iterative stakeholder-engaged process of developing candidate implementation strategies for future testing. Study results will inform the design of a future Type 2 hybrid trial to further optimize SBI-HV and rigorously evaluate companion implementation strategies.